SHARP Patient Education and Resource Feedback Form

Please take three minutes to provide feedback on the educational resource you received. Your feedback matters to us!

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* 1. I am a:

Surgical Patient

Family Member

Caregiver

Other (please specify)

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* 2. What is your age?

Under 18

18-29

30-49

50-64

65 or older

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* 3. What is your gender?

Male

Female

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* 4. What type of surgery will or did you have?

Carpal Tunnel Release

C-section

Dental

Ear, Nose and Throat Procedures (Tonsillectomy and Adenoidectomy)

Gallbladder Removal

General Surgery

Hernia Repair

Ortho/Sports Med (Knee/Shoulder)

Sleep Apnea Implant

Spinal Cord Simulator

Total Joint Replacement

Urology (laser lithotripsy, ureteroscopy, cystoscopy)

Other (please specify)

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* 5. How helpful were the educational materials you received before surgery?

Extremely helpful

Very helpful

Somewhat helpful

Not so helpful

Not at all helpful

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* 6. Were the instructions for pre-operative preparation clear and easy to follow?

Yes

Somewhat

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* 7. Did the materials explain what to expect during recovery?

Yes

Somewhat

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* 8. Was the information presented in a way that was easy to understand?

Yes

Somewhat

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* 9. Did you have access to the materials in your preferred language?

Yes

If no, what is your preferred language?

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* 10. When did you receive the education materials?

Well before surgery

A few days before

The day of surgery

After surgery

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* 11. Was this timing appropriate for you to feel prepared?

Yes

If no, please explain

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* 12. Did you know who to contact if you had questions after reviewing the materials?

Yes

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* 13. How satisfied are you with the surgical education and support you received?

Very satisfied

Satisfied

Neither satisfied nor dissatisfied

Dissatisfied

Very dissatisfied

SHARP Patient Education and Resource Feedback Form

Question Title

* 1. I am a:

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* 2. What is your age?

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* 3. What is your gender?

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* 4. What type of surgery will or did you have?

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* 5. How helpful were the educational materials you received before surgery?

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* 6. Were the instructions for pre-operative preparation clear and easy to follow?

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* 7. Did the materials explain what to expect during recovery?

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* 8. Was the information presented in a way that was easy to understand?

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* 9. Did you have access to the materials in your preferred language?

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* 10. When did you receive the education materials?

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* 11. Was this timing appropriate for you to feel prepared?

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* 12. Did you know who to contact if you had questions after reviewing the materials?

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* 13. How satisfied are you with the surgical education and support you received?

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* 14. What did you find most helpful about the educational materials/resources?

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* 15. What could be improved in the materials or support you received?